Clinical outcomes of bronchiectasis in India: data from the EMBARC/Respiratory Research Network of India registry
Authors: Raja Dhar, Sheetu Singh, Deepak Talwar, B.V. Murali Mohan, Surya Kant Tripathi, Rajesh Swarnakar, Sonali Trivedi, Srinivas Rajagopala, George D'Souza, Arjun Padmanabhan, B. Archana, P.A. Mahesh, Babaji Ghewade, Girija Nair, Aditya Jindal, Gayathri Devi H. Jayadevappa, Honney Sawhney, Kripesh Ranjan Sarmah, Kaushik Saha, Suresh Anantharaj, Arjun Khanna, Samir Gami, Arti Shah, Arpan Shah, Naveen Dutt, Himanshu Garg, Sunil Vyas, Kummannoor Venugopal, Rajendra Prasad, Naveed M. Aleemuddin, Saurabh Karmakar, Virendra Singh, S.K. Jindal, Shubham Sharma, Deepak Prajapat, Sagar Chandrashekar, Michael Loebinger, Aditi Mishra, Francesco Blasi, Ramanathan Palaniappan Ramanathan, Pieter C. Goeminne, Preethi Vasudev, Amelia Shoemark, B.S. Jayaraj, Rahul Kungwani, Akanksha Das, Mehneet Sawhney, Eva Polverino, Tobias Welte, Nayan Sri Gulecha, Michal Shteinberg, Anshul Mangala, Palak Shah, Nishant Kumar Chauhan, Nikita Jajodia, Ashutosh Singhal, Sakshi Batra, Ashfaq Hasan, Stefano Aliberti, Megan L. Crichton, Sneha Limaye, Sundeep Salvi, James D. Chalmers
Journal: European Respiratory Journal (2022)

Background Identifying risk factors for poor outcomes can help with risk stratification and targeting of treatment. Risk factors for mortality and exacerbations have been identified in bronchiectasis but have been almost exclusively studied in European and North American populations. This study investigated the risk factors for poor outcome in a large population of bronchiectasis patients enrolled in India. Methods The European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC) and Respiratory Research Network of India (EMBARC-India) registry is a prospective observational study of adults with computed tomography-confirmed bronchiectasis enrolled at 31 sites across India. Baseline characteristics of patients were used to investigate associations with key clinical outcomes: mortality, severe exacerbations requiring hospital admission, overall exacerbation frequency and decline in forced expiratory volume in 1 s. Results 1018 patients with at least 12-month follow-up data were enrolled in the follow-up study. Frequent exacerbations (≥3 per year) at baseline were associated with an increased risk of mortality (hazard ratio (HR) 3.23, 95% CI 1.39–7.50), severe exacerbations (HR 2.71, 95% CI 1.92–3.83), future exacerbations (incidence rate ratio (IRR) 3.08, 95% CI 2.36–4.01) and lung function decline. Coexisting COPD, dyspnoea and current cigarette smoking were similarly associated with a worse outcome across all end-points studied. Additional predictors of mortality and severe exacerbations were increasing age and cardiovascular comorbidity. Infection with Gram-negative pathogens (predominantly Klebsiella pneumoniae ) was independently associated with increased mortality (HR 3.13, 95% CI 1.62–6.06), while Pseudomonas aeruginosa infection was associated with severe exacerbations (HR 1.41, 95% CI 1.01–1.97) and overall exacerbation rate (IRR 1.47, 95% CI 1.13–1.91). Conclusions This study identifies risk factors for morbidity and mortality among bronchiectasis patients in India. Identification of these risk factors may support treatment approaches optimised to an Asian setting.